I recently went for a routine mammogram. I should have realized things were going to go badly when I had to check in at a central area rather than the mammogram waiting room. After the initial check-in, I then waited 50 minutes to be called to yet another room where I would receive my wristband ID that was the ticket into the mammogram room.

The clerk asked me for my basic personal information as if I was a new patient, even though I’ve been going to the same facility for more than 15 years. I jokingly said, “Did you lose my information overnight?” She replied, “Well, we just went through a systems upgrade.” I laughed and said, “It doesn’t seem like much of an upgrade if you’ve lost all the information – LOL.” Her response was a stony glare and a big red check on my paperwork. I immediately got that sinking feeling you get when you realize you’ve been flagged for a “special” groping at a TSA checkpoint, and was thankful I wasn’t there for a colonoscopy.

After submitting my driver’s license, insurance card and fingerprints ☹, I was finally instructed to go sit in the mammogram waiting room. The clerk proceeded to ask if I had a doctor’s order. I informed her that they themselves told me I did not need a doctor’s order for this routine mammogram when I went through the preapproval process two months ago. She begrudgingly called my doctor’s office and, 20 minutes later, I was finally taken into the back for my mammogram (which took all of 5 minutes). As with just about every medical procedure, up to and probably including radical brain surgery, the hospital paperwork took much longer than the procedure itself.

While the healthcare system spends billions of dollars and an infinite amount of patient’s time to ensure they get all their ducks in a row to get paid by the insurance companies, 400,000 people die every year from malpractice in hospitals. In 1996 the National Institutes of Medicine revealed that up to 98,000 people die every year from malpractice and I thought that fact was alarming. Is it possible that in 2014 healthcare is getting worse instead of better? How is it that the number of deaths from malpractice is four times larger than it was just 17 years ago?

ALMOST 1,100 PEOPLE WILL DIE TODAY, TOMORROW AND EVERY DAY THEREAFTER due to preventable harm. This is equivalent to five 787 Dreamliners crashing every day. Hospital errors are now the third leading cause of death in the U.S. right behind cancer and heart disease. If that doesn’t make CLNC® consultants, hospital RNs and MDs sit up straight and take notice I don’t know what will.

It’s time for the healthcare system to put as much effort (and more working RNs) into the actual delivery of healthcare as they do into verifying insurance, repeatedly collecting personal information and getting ready for the next Joint Commission audit. This needs to happen quickly as the Affordable Care Act (commonly known as “ObamaCare”) will only be injecting more potential victims (with already bad prognoses) into an already faulty healthcare system.

400,000 patients are dying in hospitals from malpractice every year while administrative paperwork takes (and lives) forever. If five Dreamliners crashed every day the media would be up in arms. Instead, this silent epidemic goes unnoticed and uncommented upon. I say instead of debating the current laws we should instead focus on fixing the killing machine known as the U.S. healthcare system. While RN jobs are at huge risk for liability, Certified Legal Nurse Consultants at least have their jobs and futures guaranteed. Is this a great country for CLNC entrepreneurs or what?

I’m Just Sayin’

P.S.Comment and tell me whether you agree or disagree that there’s too much emphasis on paperwork and too little emphasis on patient care.

I totally agree. More is required of the bedside nurse in order for the hospital to get reimbursed, but there still remains only 12 hours to a shift with no overtime allowed. Yet the nurse still has to fulfill her duties, which includes to chart everything done and said that has a potential to loose one’s hard-earned license.

Vickie, you said, “the hospital paperwork took much longer than the procedure itself.” I agree with Diana about getting all the duties done before clocking out. I believe nurses are pushed so hard for the newest of forms to fill out that it takes the focus away from actual quality care. It only takes minutes or even seconds for errors or neglect to happen.

I felt I had to quit my last job because management was making us psych nurses do audits every shift on every patient on the 16 bed unit and two RNs on day shift. I felt that it placed me as a nurse at a big risk for liability (you hit the nail on the head, Vickie). The audits were additional work to be done while taking care of a patient load. The nurses were tied up in the office during all shifts on the computers. That is no way to safely run a psych unit.

Anyone who knows about management can see that this is mismanaging audits. Audits are not to take the place of patient care according to the National State Boards of Nursing. Do you think coming from an opinionated seasoned nurse that anyone would listen? No. Like you said Vickie, “That makes our future more secure as CLNC® consultants.”

I agree! For example, I injured my knee on vacation and was barely able to walk. My orthopedic MD had me go to the ER for an exam and x-ray. I went to the ER, sat in the waiting room for an hour and was finally called back. I said I had significant pain and difficulty walking. The med tech said they were out of wheelchairs and I had to walk to the exam room (which was quite a distance). After being examined by a physician assistant, I had to walk to radiology (still out of wheelchairs). When the x-ray was complete, I had to walk back to the exam room. While I was waiting, a respiratory therapist came in to give me a breathing treatment. I said I didn’t need a breathing treatment, but she was insistent that if I didn’t take the breathing treatment, I wouldn’t be discharged home. She said, “Now Ms. Johnson, don’t be difficult.” I said, “I’m NOT Ms. Johnson.” “OH,” she said and then she left. She never checked my armband or asked me my name! Then a med tech came in to wrap my knee with an ace wrap, gave me crutches and said I could go home. When I asked about my x-ray, she went out to the desk and they told her to tell me my x-ray was fine and I could leave. They did have a wheelchair for discharge. When I went into my MD’s office the next day, he said, “WOW! Did you see the x-ray?” I had one of the largest collagen foreign bodies that he had ever seen and it had lodged behind my knee and was pushing on a nerve. He said I needed immediate surgery which I had the next day.
There were so many errors and omissions in my short stay – it was ridiculous! Wrong information on my x-ray, no teaching to the ace wrap, walking on crutches, safety issues etc., etc., etc.
The healthcare system is pretty scary these days!!

I definitely agree. After coming out of PACU into “computer” work, I have seen how much repetitive documentation that we are producing. I understand the importance of verifying patient information but the waiting is what gets most “customers” in healthcare. We have computerized everything to make it more centralized, but why is there more time waiting? We are bogged down in paperwork and cannot give patients the time they deserve.

I recently read an article on Fierce EMR, where they described a new program at Mount Sinai:
“The EMR intervention program triggered a red alert based on subtle changes in vital signs, including higher temperatures and pulse or breathing rates, that rarely prompted intervention in the past, according to the report.”
“There was a much greater appreciation of the seriousness that is suggested by these abnormalities in vital signs, and a significant reduction in any apprehension that may have existed before to call on an advanced-level provider,” Charles Powell, Mount Sinai chief of pulmonary and critical care medicine, told CMAJ.
The article goes on to say “two physicians writing in Forbes argued that a simple blood test and adoption of a protocol could save nearly 70,000 Americans each year from dying of sepsis in hospitals.”
What have we nurses been saying for years? It took a computer to tell the MD to “have a much greater appreciation of the seriousness suggested by these abnormalities”? And a protocol is going to save everyone!
Nurses know patients better than anyone else on the care team. Nurses have attempted to trigger warnings to MDs about these subtle changes in vital signs for years! Here we are, fancy EMRs, protocols up to your eyeballs, billions or dollars in the whole, and we still have a major problem. Nurses are being left out of the equation and I am disappointed the ANA has not been successful gaining ground here.
Not a week goes by without my hearing another story of medical errors, blunders, and near misses from family and friends. This is too close to home to ignore. Too much paperwork, redundancy, a useless multi-million dollar computer program, and not enough emphasis on direct patient care? That’s a definite yes.

You hit the nail on the head, Joanne. Nurses are left out of the equation. Doctors do not talk to us about their patients, administration does not include us in policy creation or changes, and we are not included in the EMR/EHR design; only teaching other nurses about implementation.

The problems are not with the electronic health systems, they are with the design. Unless those who actually use the system are utilized at the very core of its creation, it is a totally useless system. The whole purpose of nurses even using the system is to monitor our actions and inactions for review – not to make patient care better, not to streamline processes.

I could not agree more!! I am a nurse manager for an internal medicine practice in Buffalo, NY that I have worked for for 25 years. I am swamped with paperwork with little time for direct patient care/teaching which I enjoy very much. Two weeks ago I was made aware of a situation where a lightweight manual wheelchair was taken away from a bilateral amputee patient…NEW amputee patient who had recently been discharged from a rehab facility. I was furious!!! I could not believe this was for real and was convinced that there must be a mistake, so I called the patient’s daughter myself to confirm this. After confirming that this was true I called the company myself. The company stated to my staff nurse that they did not receive the CMN form which we had completed and faxed to them less than 1 month prior. The person from the company that was dealing with this patient’s account was rude and acted completely inappropriately. She actually gave the direction for the wheelchair to be removed from the home. I called the manager of the company and explained what had occurred and of course she was basically speechless, trying very poorly to come up with a possible way to correct the situation. I explained to her that I already had another company deliver a wheelchair to this patient and that their services would no longer be needed and stressed to her how wrong and unethical this was and that this is not the way that our company takes care of our patients. Not only did they remove a wheelchair, but they removed it from a patient who had no legs!!!! Even if we had not completed the form correctly or timely (which we had), this was completely inappropriate and actually cruel. Is this what healthcare has come to? I am very concerned and actually disheartened as to where healthcare is headed.